二尖瓣狭窄合并左心耳血栓患者经溶栓及联合抗凝后的球囊扩张术

Safety and efficacy of percutaueous balloon mitral valvuloplasty in patients with mitral stenosis and thrombus in left atrial appendage after thrombolytic and anticoagulation therapy

目的评价二尖瓣狭窄合并左心耳血栓患者尿激酶溶栓及阿司匹林、低分子肝素联合抗凝后经皮二尖瓣球囊扩张术(PBMV)治疗的可行性、安全性和有效性。方法选择经尿激酶溶栓及阿司匹林、低分子肝素联合抗凝治疗7d的二尖瓣狭窄合并左心耳血栓患者25例,采用Inoue单球囊技术行PBMV.术后随访1年以上,观察术中及随访期间有无血栓栓塞并发症。结果手术成功率100%,术中及随访期间无1例发生血栓栓塞并发症。术后即刻及随访期间血流动力学、心功能明显改善。结论对于经尿激酶溶栓及加用阿司匹林、低分子肝素联合抗凝治疗后的二尖瓣狭窄合并左心耳血栓患者,PBMV安全可行,疗效满意。

[Objective] To evaluate the safety and efficacy of percutaueous balloon mitral valvuloplasty（PBMV） in patients with mitral stenosis and thrombus in the left atrial appendage after thrombolytic and anticoagulation therapy. [Methods] We selected 25 patients. All cases received Urokinase, Aspirin and Low-molecular-weight Heparins calcium every day for 7 day before underwent PBMV used Inoue single balloon technique, to see whether systemic thromboembolism complication occurred during the operation and one year follow-up term. [Results] The successful rate of PBMV was 100%. No systemic thromboembolism occurred during and after PBMV. The parameters of hemodynamics, mitral valve area and cardiac function improved markedly. [Conclusion] In patiens with mitral stenosis and thrombus in the left atrial appendage, PBMV is safe and effective after certain thrombolytic and anticoagulation therapy.